Stylistic considerations

Qualitative research differs from quantitative research in some very fundamental ways. Qualitative researchers represent a basic level of inquiry that seeks to discover and understand concepts, phenomena, or cultures. Jackson and colleagues (2007) state the primary focus of qualitative research is to understand human beings’ experiences in a humanistic and interpretive way (p. 21). In a qualitative study you should not expect to find hypotheses; theoretical frameworks; dependent and independent variables; large, random samples; complex statistical procedures; scaled instruments; or definitive conclusions about how to use the findings. Because the intent of qualitative research is to describe, explain, or understand phenomena or cultures, the report is generally written in a narrative that is meant to convey the full meaning and richness of the phenomena or cultures being studied. This narrative includes subjective comments that are intended to provide the depth and richness of the phenomena under study.

The goal of a qualitative research report is to describe in as much detail as possible the “insider’s” or emic view of the phenomenon being studied. The emic view is the view of the person experiencing the phenomenon reflective of his or her culture, values, beliefs, and experiences. What the qualitative researcher hopes to produce in the report is an understanding of what it is like to experience a particular phenomenon or be part of a specific culture.

One of the most effective ways to help the reader understand the emic view is to use quotes reflecting the phenomenon as experienced. For this reason the qualitative research report has a more conversational tone than a quantitative report. In addition, data are frequently reported using concepts or phrases that are called themes (see Chapters 5 and 6). A theme is a label. Themes represent a way of describing large quantities of data in a condensed format. To illustrate the application of a theme and how it helps the reader understand the emic view, the following is offered from a report published by Seiler and Moss (2012, Appendix C). The authors’ purpose is to “gain insights into the unique experiences of nurse practitioners (NPs) who provide health care to the homeless.” The following quote is used by Seiler and Moss to demonstrate the theme of “making a difference.” Using the informant’s words, the researchers share how working with the homeless makes a difference:

The richness of the narrative provided in a qualitative research study cannot be shared in its entirety in a journal publication. Page limitations imposed by journals frequently limit research reports to 15 pages. Despite this limitation, it is the qualitative researcher’s responsibility to illustrate the richness of the data and to convey to the audience the relationship between the themes identified and the quotes shared. This is essential in order to document the rigor of the research, which is called trustworthiness in a qualitative research study. It is challenging to convey the depth and richness of the findings of a qualitative study in a published research report. A perusal of the nursing and health care literature will demonstrate a commitment by qualitative researchers and journal editors to publish qualitative research findings. Regardless of the page limit, Jackson and colleagues (2007) offer that it is the researcher’s responsibility to ensure objectivity, ethical diligence, and rigor regardless of the method selected to conduct the study. Fully sharing the depth and richness of the data will also help practitioners to decide on the appropriateness of applying the findings to their practice.

There are some journals that by virtue of their readership are committed to publication of more lengthy reports. Qualitative Health Research is an example of a journal that provides the opportunity for longer research reports. Guidelines for publication of research reports are generally listed in each nursing journal or are available from the journal editor. It is important to note that criteria for publication of research reports are not based on a specific type of research method (i.e., quantitative or qualitative). The primary goal of journal editors is to provide their readers with high quality, informative, timely, and interesting articles. To meet this goal, regardless of the type of research report, editors prefer to publish manuscripts that have scientific merit, present new knowledge, support the current state of the science, and engage their readership. The challenge for the qualitative researcher is to meet these editorial requirements within the page limit imposed by the journal of interest.

Nursing journals do not generally offer their reviewers specific guidelines for evaluating qualitative and quantitative research reports. The editors make every attempt to see that reviewers are knowledgeable in the method and subject matter of the study. This determination is often made, however, based on the reviewer’s self-identified area of interest. Research reports are often evaluated based on the ideas or philosophical viewpoints held by the reviewer. The reviewer may have strong feelings about particular types of qualitative or quantitative research methods. Therefore it is important to clearly state the qualitative approach used and, where appropriate, its philosophical base.

Fundamentally, principles for evaluating research are the same. Reviewers are concerned with the plausibility and trustworthiness of the researcher’s account of the research and its potential and/or actual relevance to current or future theory and practice (Horsburgh, 2003, p. 308). The Critiquing Criteria: Qualitative Research box below provides general guidelines for reviewing qualitative research. For information on specific guidelines for appraisal of phenomenology, ethnography, grounded theory, historical, and action research, see Streubert and Carpenter (2011). If you are interested in additional information on the specifics of qualitative research design, see Chapters 5 and 6.

Application of qualitative research findings in practice

The purpose of qualitative research is to describe, understand, or explain phenomena or cultures. Phenomena are those things that are perceived by our senses. For example, pain and losing a loved one are considered phenomena. Unlike quantitative research, prediction and control of phenomena are not the aim of the qualitative inquiry. Therefore, qualitative results are applied differently than more traditional quantitative research findings. Barbour and Barbour (2003, p. 185) state that

Further, Barbour and Barbour (2003) offer that qualitative research can provide the opportunity to give voice to those who have been disenfranchised and have no history. Therefore the application of qualitative findings will necessarily be context-bound (Russell & Gregory, 2003). This means that if a qualitative researcher studies, for example, professional dignity in nursing, the application of these findings is confined to individuals who are similar to those who informed the research.

Qualitative research findings can be used to create solutions to practical problems (Glesne, 1999). Qualitative research also has the ability to contribute to the evidenced-based practice literature (Cesario et al., 2002; Gibson & Martin, 2003; Walsh & Downe, 2005). For instance, in the development of a grounded theory study of the emotional process of stroke recovery, Gallagher (2011) shares how critical it is for care providers to let their patients set goals despite practitioners’ level of knowledge and experience. As the author in this research report points out, those recovering from stroke at times feel a dissonance from their provider. Once stroke victims have their basic needs met, they report an incongruity between the goals they set for themselves and what their therapists see as priorities.

It is important to view research findings within context, whether quantitative or qualitative. For instance, a quantitative study of survivorship in female breast cancer survivors (Meneses et al., 2007) should not be viewed as applicable to survivors of another “survivor” situation such as an epidemic or mass casualty. The findings must be used within context, or additional studies must be conducted to validate the applicability of the findings across situations and patient populations. This is true in qualitative research, as well. Nurses who wish to use the findings of qualitative research in their practice must validate them, through thorough examination and synthesis of the literature on the topic, through their own observations, or through interaction with groups similar to the study participants, to determine whether the findings accurately reflect the experience.

Morse and colleages (2000) offer “qualitative outcome analysis (QOA) [as a] systematic means to confirm the applicability of clinical strategies developed from a single qualitative project, to extend the repertoire of clinical interventions, and evaluate clinical outcomes” (p. 125). Using this process, the researcher employs the findings of a qualitative study to develop interventions and then to test those selected. Qualitative outcome analysis allows the researcher/clinician to implement interventions based on the client’s expressed experience of a particular clinical phenomenon. Further, Morse and colleagues (2000) state, “QOA may be considered a form of participant action research” (p. 129). Application of knowledge discovered during qualitative data collection adds to our understanding of clinical phenomena by using interventions that are based on the client’s experience. QOA is considered a form of evaluation research and as such has the potential to add to evidence-based practice literature either at Level V or at Level VI depending on how the study is designed.

Another use of qualitative research findings is to initiate examination of important concepts in nursing practice, education, or administration. For example, surgical consent as a concept has been studied using both qualitative and quantitative methods. It is considered a significant responsibility in nursing. Therefore studying its multiple dimensions is important. In a study by Cole (2012), the author examined implied consent as it relates to patient autonomy. The informants were nurses in a one day surgical unit. The outcome of her research was a richer understanding of how nurses view implied consent and the dimensions of the relationship necessary for the patient to exercise his or her autonomy. The study adds to the existing body of knowledge on patient consent and extends the current state of the science by examining a specific area of nursing practice and the experience of practicing nurses. This type of study is at Level V or VI, which includes either systematic reviews or single studies that are descriptive or qualitative in their design (see Chapter 1).

Meta-synthesis is also a widely accepted method of synthesizing findings from a number of qualitative research studies in an attempt to further validate the conceptualizations found among individual qualitative studies. According to Finfgeld-Connett (2010) meta-synthesis is a way of integrating findings from a number of disparate investigations to increase their utilization in practice and in policy formation. Further, when these evidentiary-based generalizations are made, they add to the generalizability and transferability of the research (p. 252).

Finally, qualitative research can be used to discover evidence about phenomena of interest that can lead to instrument development. When qualitative methods are used to direct the development of structured measurement instruments, it is usually part of a larger empirical research project. Instrument development from qualitative research studies is useful to practicing nurses because it is grounded in the reality of human experience with a particular phenomenon and informs item development. A study completed by Richards (2008) illustrates the use of both qualitative and quantitative methods to develop, revise, and test a pain assessment instrument.